Eli S. Fredman, Hadeel Allam, Nidhy P. Varghese, Daisuke Kobayashi, Manish Aggarwal, R. Mark Grady, David Balzer
Washington University School of Medicine and St Louis Children’s Hospital. Baylor College of Medicine and Texas Children’s Hospital.
United States
Journal of the American College of Cardiology Case Reports
JACC Case Rep 2026;
DOI: 10.1016/j.jaccas.2026.108137
Abstract
Background: Severe pulmonary arterial hypertension (PAH) with bidirectional patent ductus arteriosus (PDA) presents a challenge, as ductal closure is contraindicated.
Case summary: A 14-year-old boy with severe PAH and bidirectional PDA experienced exercise intolerance. He underwent transcatheter placement of a 20-mm folded Melody valve within the native PDA. The procedure eliminated diastolic left-to-right shunting while preserving systolic right-to-left shunting. At 1-year follow-up, he demonstrated durable unidirectional shunting and improved to NYHA functional class I status.
Discussion: While surgical valved reverse Potts shunts exist in the literature, adapting a transcatheter valve to create a unidirectional shunt within the native PDA percutaneously is novel. It offers a less invasive alternative for managing suprasystemic PAH.
Take-home messages: Transcatheter folded valve placement within a native PDA safely establishes a unidirectional right-to-left shunt. This intervention reduces pulmonary overcirculation while maintaining vital ventricular decompression.
Category
Class I. Pulmonary Hypertension Associated with Congenital Cardiovascular Disease
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes